Classification
Any system of fracture classification helps in communication between clinicians and may aid in
decisions of management and prognosis. The system of classification of open fractures into three types of
increasing severity was first introduced by Veliskakis5
. This concept was fully developed by Gustilo and
Anderson6
. It was subsequently modified by Gustilo et al7
and is the most commonly used classification
and is shown below in Table 2. The above classification had an interobserver agreement of about 60% as
shown by Brombark and Jones in a study of classification of tibial fractures by 245 orthopedic surgeons8
.
Because of this disagreement, it advisable to classify open fractures in operating theatre after extending
the wound, assessing the contamination and state of the fractured bone and soft tissues. The risk of
clinical infection as shown in a study by Patzakis and Wilkins is shown in the table below and depend on
fracture characteristic and location9
. The infection of tibia fractures is twice that of other locations.